Enhancing Trauma-Informed Approaches in Behavioral Healthcare

08/11/2017

Behavioral health service providers increasingly view trauma as an important element that must be addressed in providing effective services for mental and substance use disorders. Trauma may occur as a result of violence, abuse, neglect, loss, disaster, war and other emotionally harmful experiences. Left unaddressed, it may lead to long lasting effects that can compromise a person’s behavioral, emotional, cognitive, and physical health.

SAMHSA, through its Strategic Initiative on Trauma and Justice, has been a leader in identifying and supporting ways that service systems can become more attuned to trauma-related issues and skilled in responding to them. Efforts include public education to raise awareness, prevention and early identification efforts, technical assistance for developing trauma-informed service environments, and trauma-specific treatment.

SAMHSA’s work in this area was strongly influenced by two seminal research studies:

SAMHSA’s Women, Co-occurring Disorders and Violence Study, which revealed greatly improved program outcomes when trauma and violence were addressed as underlying causes in delivering services to people with mental and substance use disorders.
The Adverse Childhood Experiences (ACE) Study, conducted by the Centers for Disease Control in partnership with Kaiser Permanente in California, which examined the effects of a range of adverse childhood events on adult health and development.

Two of SAMHSA’s key efforts to address trauma are the National Child Traumatic Stress Network and the National Center for Trauma-Informed Care.

National Child Traumatic Stress Network

The National Child Traumatic Stress Network (NCTSN) is a nationwide network of researchers, intervention developers and service providers whose objective is to improve the access to and quality of services for children and families exposed to trauma. The NCTSN was established by Congress in 2000 under the Children’s Health Act that provides funding through the National Child Traumatic Stress Initiative (NCTSI). The NCTSI also supports a National Child Trauma Coordinating Center to manage the network, grants to intervention developers and grants for community service providers, as well as learning collaboratives in trauma-specific areas.

How NCTSN Works

As the network grantees and members work to address the needs of children and families, they also benefit from collaboration with one another. Treatment and Service Adaptation (TSA), centers run by universities and medical centers, develop evidence-based practices for which they then provide training throughout the network. Community Treatment and Services Centers of frontline and community organizations work together and also benefit from the TSA training.

The NCTSN facilitates the formation of collaborative workgroups or committees guided by strategic plans for specific areas such as child welfare, sexual abuse, trafficking, medical trauma, community trauma, and traumatic experiences of refugees and immigrants. These workgroups give grantees and members the opportunity to work together to advance practices with a specific topic in mind.

The NCTSN also hosts a Learning Center that offers free, open-forum training for providers and others supporting children who have experienced traumatic events. The trainings are self-paced and flexible, and CEUs are available for providers. This resource also includes podcasts, content on specific populations, and clinical training. Through the Learning Center and additional training events delivered by grantees, the NCTSN provides training to more than 200,000 participants annually.

National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint

SAMHSA’s National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint(NCTIC) focuses on reducing the use of seclusion and restraint through trauma-informed culture change in publicly funded organizations, systems, and communities. It provides training, technical assistance, and consultation to increase understanding and responsiveness to trauma in behavioral health, offering on-site and virtual support, as well as Virtual Learning Communities, webinars, and online tools.

NCTIC stresses the importance of involving trauma survivors and service recipients in all aspects of its work and in trauma-informed culture change, from conceptualization to implementation and evaluation.

In addition to providing technical assistance, facilitating collaboration, and awarding grants to continue this work, SAMHSA recently initiated an effort to train all agency staff in ways to understand and integrate a trauma-informed approach in SAMHSA grants, contracts, and program and policy development.